HEALTH

HEALTH; Personal Health

By Jane E. Brody

Published: May 5, 1988

With asthma in children on the increase, experts lament that a host of effective new drugs are being underused or improperly used. As a result, asthma is now a more serious threat to the health of American children than ever before and, by all indications, the problem is getting worse.

Experts are calling upon parents to assume a leadership role in controlling the frequency and severity of their children's asthma attacks. They are also urging parents to act aggressively to get the best medical care available, the kind of care that can minimize the risk of life-threatening complications and maximize the chances of a normal life for nearly all children with asthma.

The experts cite a variety of misconceptions about this breath-robbing ailment that seem to be blocking more effective treatment. Among the many mistaken beliefs are these:

Myth: Asthma is uncommon in children today.

Fact: More than eight million children have had asthma attacks and more than two million suffer from asthma nearly all the time. Many other children are believed to have the disease, but it has not been properly diagnosed. Asthma is the leading cause of absenteeism from school and one of the 10 most frequent reasons for visits to pediatricians. Furthermore the prevalence and the severity of childhood asthma seem to be on the increase.

Myth: With modern medications, asthma is no longer a serious threat.

Fact: While drugs are now available to control even the most severe cases, most children who might benefit are not receiving optimal care. As a result serious asthma attacks and asthma deaths are dramatically rising. Hospitalizations of asthmatic children under the age of 17 more than doubled from 1970 to 1983, and asthma deaths in children doubled from 1977 to 1984. Yet, the experts said, no one would die from asthma if modern treatments were used correctly. They cited delays is seeking care and the administration of inadequate or inappropriate treatment as the main reasons for this crisis.

Myth: Asthma therapy is worse than the disease. The drugs make children hard to manage and interfere with learning.

Fact: New drugs and better methods of administration avoid most of the unpleasant side effects.

Myth: Asthma is a psychological problem and the best way to deal with it is to ignore it.

Fact: Asthma is a physical illness that can be exacerbated by emotional factors but not caused by them. Underreacting to the problems of the child with asthma is likely to worsen the disease. Similarly, ignoring the psychological and behavioral aspects of the disease can result in a child with serious adjustment problems.

Proper management of asthmatic children is often undermined by doctors who are not knowledgeable about modern treatments, said Dr. Martha V. White of the National Institute of Allergy and Infectious Disease. The principles of asthma therapy and the specific medications have dramatically changed in the last decade, and many pediatricians and family physicians, who treat most children with asthma, have not yet learned the latest tactics.

Furthermore, more than half of asthma care is delivered in hospital emergency rooms, where acute attacks are treated but little attention is paid to preventing future attacks and developing a treatment plan that can minimize the severity of the disease, said Dr. Floyd J. Malveaux, clinical immunologist at the Johns Hopkins University School of Medicine.

Emergency treatment usually deals with the symptoms - the wheezing, coughing and shortness of breath - not the underlying disease. Yet the latest research shows that the hidden effects must be treated to avert future severe attacks. What is Asthma? Asthma is a disease of the respiratory tract in which the airways constrict, drastically reducing the flow of air into and out of the lungs. Patients liken it to trying to breathe through a straw. In most children with asthma, the symptoms are precipitated by exposure to an allergen or irritant, such as tobacco smoke, animal dander, fur or feathers, house dust, pollens and mold spores, certain foods, drugs or food chemicals, air pollutants, household cleaning products, perfumes, paints and aerosol sprays.

Factors like breathing air that is cold, hot, humid or dry can cause an asthma attack, as can abrupt weather changes, vigorous exercise, catching a cold or getting overtired. Emotional reactions, like laughing too hard or becoming angry or overly stressed, can also cause an attack.

In an attack, muscles in the walls of the airways go into spasm. Tissues lining the airways respond by secreting more mucus. The result is a very narrow or blocked passage.

But even the definition of the disease has changed in recent years. As Dr. William J. Davis, a pediatrician at Columbia University College of Physicians and Surgeons, put it: ''In 1978, asthma was defined as wheezing and shortness of breath that were usually reversible. In 1988, we recognize it to be much more complex.''

He said the initial attack was only a small part of the story. Even after breathing has eased, further damage may be done that makes the airways hyperreactive for days, months or even years. This damage involves chronic inflammation of the bronchii and bronchioles, which can precipitate spasms after exposure to allergens or irritants that might not otherwise be troublesome. A child whose hyperreactive airways remain untreated is likely to have increasingly frequent and severe asthma attacks. Modern Treatment

Dr. Davis noted that while bronchodilators, the mainstay of asthma treatment, reopen blocked airways, ''they play no role in the late-phase reaction, and their overuse can make matters worse by masking the severity of the disease.'' In other words, if an asthmatic relies on bronchodilators to ease breathing but fails to treat the underlying inflammation, the delayed effect can become so severe that a future attack could quickly become a life-threatening emergency.

Two drugs are excellent for countering hyperreactivity: cromolyn sodium and inhaled steroid. Both are less likely to produce unwanted side effects than theophylline, the medication currently widely used for this purpose. Cromolyn, which is inhaled, was recommended by the experts as the best all-around drug for moderate or moderately severe asthma. The Parents' Role

Dr. Clifton Furukawa, pediatrician at the University of Washington School of Medicine, noted that modern asthma treatment for children involves far more than drugs and doctors. Parents have to play a primary role. They must help the child identify and avoid the allergens and irritants to which the child is sensitive, especially tobacco smoke and furry or feathery pets.

In some cases, children can be desensitized by shots for allergens like pollens and molds. The child's bedroom should be kept as free of dust and other allergens as possible, which means no rugs, curtains, venetian blinds or fuzzy blankets. Parents should also check the child's classroom for avoidable allergens.

Parents should become well-informed about asthma and the medications, realizing that it is not an acute illness but a chronic ailment requiring continuous attention.

The child's physician should outline plans for prevention and treatment and home management of the disease, as well as establishing an emergency plan. The emergency procedures should be written down and reviewed with whoever stays with the child when the parents are away. Parents should speak frankly with the child's physician about difficulties in using a particular medication or carrying out the treatment plans, such as getting rid of a beloved pet.

If, despite treatment, the child's condition worsens, parents should ask the doctor for a referral to a pediatric allergist. A worsening of asthma usually means something has been overlooked. A good source of information is the American Academy of Allergy and Immunology, 1-800-822-ASMA.

Parents should encourage asthmatic children to pursue activities normal for their age. Many asthmatic children can exercise safely by using medication beforehand. Parents should be careful not to overprotect an asthmatic child or neglect other children in the family.

''Asthma should not be the focus of family life,'' Dr. Furukawa said.

Parents should also encourage children to manage asthma on their own as much as possible. Finally, parents should share information and helpful hints with other parents of asthmatic children. WEAPONS AGAINST ASTHMA Beta-Adrenergic Bronchodilators: Albuterol (Brand names: Ventolin, Proventil); metaproterenol (Alupent, Metaprel); terbutaline (Brethine, Brethaire) Dilate airways in initial, acute attack, but do not fight underlying inflammation that can leave patient susceptible to worse attacks. Taken orally or inhaled. Used alone, can mask severity of disease. Fewer adrenalin-type side effects, such as sleeplessness and nervousness, when inhaled. Theophylline: (Slo-Bid, Theo-Dur, Theo-Lair) Dilates airways. Quickly relieves acute attacks, helps clear mucus, but does not fight inflammation. May prevent attacks in children. Taken orally. Caffeine-like side effects may include irritability, restlessness and learning disabilities. Cromolyn sodium (Intal) Used to prevent asthma attacks by decreasing underlying inflammation and sensitivity of airways. Does not immmediately relieve acute attacks. Inhaled. No significant side effects. Inhaled steroids: Triamcinalone acetonide (Azma-acetonide (Azmacort); flunisolide (Aerobid); beclomethasone (Beclovent) Fight inflammation and can reduce severity of late phase of attacks and chronic asthma. Few side effects, such as yeast infections in throat and hoarseness, at usual inhaled doses; at higher doses, same side effects as all steroids. Source: William J. Davis, M.D.